Field Guide
POTS / Dysautonomia
Postural Orthostatic Tachycardia Syndrome and related autonomic dysregulation disorders where the autonomic nervous system struggles to regulate heart rate, blood pressure, temperature, and blood flow — especially with posture changes. Often overlaps with post-viral syndromes, hypermobility (hEDS), MCAS, and mitochondrial dysfunction.
Your autonomic nervous system is your body's autopilot. In POTS, the autopilot glitches every time you stand up — heart racing, blood pooling, fog rolling in.
In plain English
The autonomic nervous system controls heart rate, blood pressure, temperature, digestion, and blood flow — automatically, in the background. In POTS (Postural Orthostatic Tachycardia Syndrome), it fails to adapt to upright posture: heart rate rises >30 bpm within 10 minutes of standing, blood pools in the legs, and the brain briefly goes under-perfused.
Symptoms include lightheadedness, near-fainting, brain fog, exercise intolerance, heat intolerance, cold extremities, and gut symptoms. Many people are dismissed as anxious for years before diagnosis.
POTS often follows a viral illness (COVID, EBV), concussion, or surgery. It overlaps heavily with MCAS, hypermobility (hEDS), Lyme, mold, and mitochondrial dysfunction — treating those upstream drivers often improves the POTS.
Where you feel it
The step-by-step
- 1Triggering event
Viral infection (often COVID or EBV), concussion, surgery, or prolonged bed rest disturbs the autonomic system.
- 2Autonomic dysregulation
The nervous system fails to constrict blood vessels on standing.
- 3Compensation
Heart rate spikes to maintain brain perfusion; catecholamines surge.
- 4Multi-system fallout
Fatigue, fog, GI symptoms, heat intolerance, exercise crashes.
Symptoms, causes & labs
- Heart racing or pounding on standing (>30 bpm rise within 10 min)
- Lightheadedness, near-fainting, fatigue on upright activity
- Brain fog, exercise intolerance, heat intolerance
- Blood pooling / mottling in legs, cold extremities
- Nausea, early satiety, bladder urgency
- Post-viral (COVID, EBV, enterovirus), post-concussion, post-surgical onset
- Hypovolemia, deconditioning, low sodium/aldosterone
- Overlap with MCAS, connective-tissue laxity (hEDS), Lyme, mold, autoimmunity
- 10-minute NASA lean test or tilt-table test
- Plasma/urine catecholamines, aldosterone, renin
- Ferritin, B12, comprehensive thyroid, morning cortisol
- Autoimmune / small-fiber neuropathy workup where indicated
Common lifestyle changes that help
These are the foundational shifts most often used alongside clinical care for this pattern. Start with one; layer in the next only when the first feels automatic. Discuss anything major with your practitioner.
- 3–5 liters of fluids and 8–10g of salt daily (unless contraindicated)
- Compression garments (waist-high 20–30 mmHg) for standing tolerance
- Recumbent exercise first (rowing, swimming, recumbent bike), progressing slowly upright
- Small, frequent meals — large meals shunt blood to the gut and worsen symptoms
- Elevate the head of the bed 4–6 inches; avoid hot showers and hot environments
Red flags — don't wait
- Chest pain, fainting with injury, or seizure-like episodes
- Sudden severe headache or vision loss on standing
- Signs of internal bleeding (black stool, severe fatigue with pallor)
Supportive habits to discuss
- Salt and fluid loading (2–3 L water, 8–10 g salt) under practitioner guidance
- Compression garments (waist-high, 20–30 mmHg) and recumbent exercise (rowing, swimming)
- Screen for and address MCAS, hEDS, mold, and Lyme — they commonly co-exist
Is this pattern showing up in your body?
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Medical disclaimer
This page is educational only. It is NOT medical advice, diagnosis, or treatment. Do not self-treat based on the information here. If you have symptoms, consult a licensed healthcare professional.